By signing below, I agree to notify Big Brothers Big Sisters of Monmouth & Middlesex Counties of any changes in my auto insurance coverage and driving record.

**Please be advised that Lexis Nexis is a well-known, web-based security check used by many volunteer based agencies. It is fully encrypted

I certify that all statements herein are complete and correct, and agree that (A) Big Brothers Big Sisters is authorized to furnish information concerning this application and are released from all liability for furnishing such information and (B) that I may be checked through Lexis Nexis*, the Department of Motor Vehicles, and Criminal and Sexual Offense databases, and (C) any misrepresentation or omission made by me in this application or any supplement hereto will be sufficient grounds for immediate termination.

I hereby authorize the addressed Police Departments and Court Houses to furnish Lexis Nexis any Criminal or Traffic Information they may have on record or otherwise, and do hereby release the addressed institution and all individual's connected therewith from all liability for damage whatsoever incurred in furnishing such information.

It is the policy of Big Brothers Big Sisters of Monmouth & Middlesex Counties, Inc. to accept volunteer applicants who in the professional opinion of the intake staff and Executive Director will provide a stable, committed, and healthy adult mentoring opportunity for an eligible child who has been accepted into our program to be matched with an adult mentor.

Whereas prospective volunteers may apply who are inappropriate for the specific needs of our program, the professional intake staff and the Executive Director may decide, based on available assessment materials, to reject a prospective volunteer at any time during the intake process or upon completion of the intake assessment. This is done through a letter to the volunteer. The applicant may request a review with the Executive Director.

Because the intake process covers an extensive amount of information, and for purposes of confidentiality, the applicant may or may not be told the reason for rejection.

A prospective volunteer agrees to accept the professional decision made realizing that this assignment is a specialized one and not suitable for all those who apply.

I understand that:

1. If I am accepted as a volunteer, I will follow all BBBS groundrules and policies including no overnight visits between Bigs and Littles.
2. The references I listed may be contacted by mail, telephone, or email;
3. I am in no way obligated to perform any volunteer services and may rescind my application at any time;
4. The information I may provide will be used to conduct a background check, to include driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth;
5. Other BBBS agencies or youth organizations where I have worked or volunteered may be contacted as references; and
6. As part of the enrollment process, I will be asked to provide additional personal information prior to acceptance into the program.